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Recommendations for participation in contact sports in certain cervical spine conditions, part A

Recommendations for participation in contact sports in certain cervical spine conditions, part A
Condition Contraindication to play
Absolute Relative* None*
Congenital anomalies
Odontoid agenesis, hypoplasia or os odontoidium X    
Type 1 Klippel-Feil mass fusion X    
Type 2 Klippel-FeilΔ congenital one-level fusion     X
Atlanto-occipital fusion X    
Spina bifida occulta     X
Atlantoaxial conditions
Atlantoaxial instability X    
Atlantoaxial rotary fixation X    
Stenosis of the spinal canal
Spear tackler's spine X    
Developmental stenosis of the spinal canal (canal/vertebral body ratio <0.8)     X
Developmental stenosis of the spinal canal with:
  • Ligamentous instability
 X    
  • Cervical cord neurapraxia with signs or symptoms lasting more than 36 hours
 X    
  • Multiple episodes of cervical cord neurapraxia
 X    
Developmental stenosis of the spinal canal with:
  • Episode of cervical cord neurapraxia
   X  
  • Intervertebral disk disease
   X  
  • MRI evidence of cord compression
   X  
Burners
Recurrent acute and chronic burners   X  
Resolved burner     X
This table provides guidance on restriction from contact or collision sports based upon specific cervical spine conditions. Some sports medicine experts would also restrict patients with these conditions from limited contact sports as well, and, if the parents/ primary caregivers were not in agreement, then make a neurosurgery or spine surgery consultation a condition of participation. This more conservative approach recognizes that, in spite of guidelines regarding return to play for various cervical spine conditions or injuries, there is limited consensus among treating physicians. This table should be used with other UpToDate content; refer to topics on musculoskeletal neck injuries in the child or adolescent athlete.

* Provided individual is asymptomatic and neurologically normal and has full range of pain-free cervical motion.

¶ Type 1 Klippel-Feil anomaly: a mass fusion of the cervical and upper thoracic vertebrae.

Δ Type 2 Klippel-Feil anomaly: one- or two-level cervical fusion with full range of cervical motion, with no evidence of spinal instability or the presence of cervical disk disease or other degenerative changes.

Adapted from: Torg JS, Ramsey-Emrhein JA. Cervical spine and brachial plexus injuries: Return-to-play recommendations. Phys Sportsmed 1997; 25:61.
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